动态脑电图在新生儿缺血缺氧性脑病中的应用研究

The application of dynamic electroencephalogram( EEG) in neonatal hypoxic ischemia encephalopathy

目的:研究动态脑电图在新生儿缺血缺氧性脑病中的应用。方法:收集2011年10月至2014年10月衡水市哈励逊国际和平医院收治的208例新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患病新生儿,检查脑电图(ambulatory electroencephalogram,AEEG)并检测其异常率,进一步对HIE患儿的近期器官损害率和AEEG之间的关系进行评估,并在治疗后的两周、3个月和6个月分别对其智能发育指数(mental development index,MDI)和运动发育指数(psychomotive development index,PDI)进行评分和复查,进一步对AEEG与HIE预后之间的关系进行评估,并观察患儿的临床疗效及预后。结果:208例HIE患儿,AEEG总的异常率为94.71%,其中轻度、中度和重度HIE患儿的异常率分别为91.07%、98.27%和100%,HIE临床分级越高,脑电图异常率及异常程度越重差异均有统计学意义(P<0.05)。对于AEEG正常的HIE患儿,其近期器官损害的发生率为9.09%;对于AEEG轻度异常、中度异常和重度异常的HIE患儿,他们的近期器官损害的发生率分别为为39.43%、45.59%和77.59%,且经统计学分析差异具有显著性(P<0.05)。随访3个月,AEEG异常情况越严重,得分越低,预后越差,且经统计学分析AEEG评价分级与MDI和PDI评分呈正相关(P<0.05);而随访6个月,AEEG的检测结果与MDI评分的关系为正相关(P<0.05),而与PDI评分的关系则没有相关性(P>0.05)。结论:新生儿AEEG检查对HIE患儿预后的判断具有较高的参考价值,AEEG异常程度越重,提示预后越差,且其具有无创、简便易行、可重复性,值得在临床上进一步推广。

Objective： To study the application of the dynamic EEG in neonatal hypoxic ischemia encephalopathy. Methods：Collect 208 cases of neonatal HIE illness in our hospital from October 2011 to October 2014,check the AEEG and detect the abnormal rate,further about recent organ damage rate of children with HIE and AEEG to evaluate the relationship between,and after treatment2 weeks,3 months and 6 months respectively for the mental development index（ MDI） and psychomotive development index（ PDI） to rate and review,and further to the AEEG and to evaluate the relationship between the prognosis of HIE,and observe the clinical curative effect and prognosis of children. Results： 208 cases of children with HIE,AEEG total abnormal rate was 94. 71%,including mild son,and of the children with moderate and severe HIE abnormal rate was 91. 07%,98. 27% and 100% respectively,the higher the HIE clinical classification,abnormal EEG abnormality rate and degree of the heavier the difference had statistical significance（ P 〈 0. 05）.For AEEG normal children with HIE,the recent incidence of organ damage（ 9. 09%）; for abnormal AEEG mild,moderate and severe abnormal children with HIE in their recent incidence of organ damage were 39. 43%,45. 59% and 39. 43% respectively,with significant difference（ P 〈 0. 05）. Followed up for 3 months,AEEG anomaly,the worse the lower the score,the worse prognosis,and the statistical analysis of AEEG is closely relative to evaluation classification and MDI and PDI scores（ P 〈 0. 05）; and were followed up for 6 months,the relationship between test results and MDI scores of AEEG in positive correlation（ P 〈 0. 05）,while relations with PDI score no correlation（ P 〉 0. 05）. Conclusion： neonatal AEEG examination for children with HIE prognosis judgment is of high reference value,the heavier AEEG abnormal degree,prompt the worse prognosis,and it is noninvasive,convenient,repeatability,worthy of further promotion in clinic.